Preimplantation Genetic Diagnosis (PGD)- have you done it?

Hi everyone We met with our FS yesterday to discuss our future cycle options following a recent diagnosis of a blighted ovum.

One of the options now on the table is PGD. Our story thus far, we seem to have no trouble consistently getting blastocycts that 'look great' but unfortunately result in BFN's or m/c (chem pg, blighted ovum). We have now had a total of 7 embryo's transferred which FS believes have all been 'abnormal' in some way, i.e either sperm or egg problems. On the other hand he is also of the opinion we may have just been 'unlucky' this time and things could be different with a future pregnancy.

This is the info we have:Our FS did say he does not routinely suggest PGD for those in our situation and without a known genetic issue as 1. it is extremely expensive ($4K on top of IVF cycle with IVFA) and 2. currently the evidence doesn't show that it results in any more successful pregnancy rates than persevering with IVF. However, it does give more genetic information about what is going on and may help scientists to pick embryos to transfer with more accuracy than the current 'well they look good lets transfer them' approach.

DH and I have decided that we will at least meet with the PGD team to consider our options and the pros and cons of going through this.

We are really interested in whether others have faced this decision and either decided for or against this.

If you did go ahead, what was the experience like, and did you think it was worth the extra cost? Thanks a million!

Have you and your DH had blood karyotypes done? If not, it's worth doing that first to check if either of you has any genetic disorder or a balanced translocation. There is a Medicare rebate for the blood test, which takes 4-5 weeks to get the results.

Sorry to hear of your recent loss. Yes we have just been faced with this very decision. We got two opinions from 2 different FS's and have decided against it for now. You will see from my signature we have had 3 losses out of 11 embryo's transferred. Our last stim cycle we had 8 blastocysts suitable for freezing from 10 eggs so certainly no problm there. What we were told correlates what you have said. We were informed that pregnancy rates dropped to about 18% and that there was an error rate of about 10-15% when doing the biopsy. Both recommendations said that until we had more than 3 failed stim cycles and had tried a number of other things first they would not recommend it. We were told that it was great if there was a known chromosonal problem or genetic issue to test for otherwise it would only help in the decision to use donor eggs or not.

Hope this helps. We are currently doing our 3rd stim and using Clexane after transfer. We have been tested for many things all which are normal so we will just keep persisting for now.

We have discussed PGD, but I can't find many doctors nor scientists who really support it so have never ended up using it. In our situation, our karyotyping came back fine, but DP's sperm has an elevated number of abnormal chromosomes. We found this our by having a chromosomal (FISH) study on DP's sperm (rather than testing his blood as karyotyping does).

The problem they tell me with PGD is that most only check 5 of the 23 chromosomes. Some check 9 chromosomes. If there is a problem with the other unchecked chromosomes, PGD won't pick it up.

They tell us that the FISH study we had only tested 5 chromosomes and the level of abnormalities suggests we should have a good chance of getting a good embryo. However, after transfering 14 embryos (including 3 with 23 year old donor eggs) we've had no luck (we haven't been able to get any blasts either). The doctors are now telling us the most likely answer is there are problems with the chromosomes they can't check. They say no amount of further testing will tell us more than we already know.

I hope PGD is able to give you answers. There was a period of time where I thought it would help us, but now I'm not sure if it gives you any more answers than consistent BFP's do.

I'll be interested to check back here to see if it helps you. I really hope it does.

Perhaps the chromosomal (FISH) study might give you some answers too? It only costs $250.

Frostysmum, we had karyotype testing done last year, all clear, but thanks for the suggestion.

ForeverHopeful, thank you for sharing your story and it's reassuring we have heard similar info. I'm also sorry to hear you've had such a hard road Unfortunately, we will be heading into a 4th stim cycle next time around... I find the stats re: potential error rates particularly disturbing!

Do you mind if I ask what 'other things' have been suggested you try before going down the PGD path? And curious as to why they suggest DE rather than DS in this situation? Our FS mentioned it too and our primary issue is MFI!

Re the 'other things', we have tried low dose aspirin, clexane last cycle and this cycle, double luetal phase support i.e. 800mg progesterone pessaries daily and if no luck this cycle we are going to have a lap. I have also had a hysterscopy but that was all fine. I have not been checked for endo so that would be the intention of the lap. We have also started taking the embies to blast and have transferred 2 at a time for 4 cycles. I have started on Metformin as that apparently reduces miscarriage rate for PCOS girls and tried to control diet to Low GI to stabilise insulin levels. I also now see my chiro before transfer as the spine is all interconnected with reproductive bits etc so want to make sure that is all right. So far none of this has helped and I keep hearing you may just be unlucky 3 times. I am not sure beyond that what other things they would be considering.

Good point re the donor eggs. I thought that after too as MFI was our initial problem also but didn't ask the question at the time. My dh is adopted so we don't have a medical history there but all karotyping has come back normal. I was also tested for NK cells but normal there too.

So I don't think I have really helped you at all sorry. I guess in the end our decision was made based on the fact that even if we had some abnormal embies eventually we hopefully we stike a good one and that the odds of 30% for IVF as compared to 18% for PGD we would just hope to get lucky sooner or later.

Hi
I thought I might revive this thread as I am chasing info on PGD again and trying to make some decisions after a 2nd blighted ovum in 6 months and now a total of 5 pregnancy losses

I have an appt for a 2nd opinion with Devora Leiberman at SIVF mid Feb and was wondering if anyone has been through the PGD program there, either using the FISH technique EBEAR mentioned above or CGH?

I am particularly interested in CGH as it is able to test all 23 chromosomes however it is only becoming available at my current clinic (IVFA) later in the year and I understand SIVF has been doing this since late 2009. Not sure that this technology is available at any other clinics as yet?

Any info re: costs, time frames for a cycle would also be appreciated, thanks!

I have seen Devora in the past and really like her. Have you been able to have your losses tested?? I did and all had a chromosome problem.

In the end I used CGH (SIVF) which as you say tests 23 chromosomes. The only down side to this is the results take approx 6 weeks to come through. Therefore you have to wait another cycle before you can have your FET. SIVF are also the only clinic who do the CGH testing on site. I think IVFA send all the embryo's off to Melbourne for testing?

The cost is VERY expensive. The first payment I made was approx $10,000 and I got about $5000 back from medicare. Then for the FET another $3000 and I can't remember how much I got back from that payment????

However at the moment I would say it has all been worth it as I am now 8 wks pregnant after my first attempt. Fingers crossed I hold on to this little one because I also have suffered many m/c.

Goodluck with your journey and feel free to contact me if you have any questions.

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